The price of peace in our time
Authors: Irina Pinchuk, Bennett L. Leventhal, Tsuyoshi Akiyama, Hartmut Berger, Isabelle Secret Bobolakis, Rebecca W. Brendel, Kirsten Catthoor, Jana Chihai, Eka Chkonia, Geert Dom, Dominika Dudek, Adrian James, Afzal Javed, Marina Kupchik, Ramune Mazaliauskiene, Pavel Mohr, Lars Lien, Vinay Lakra, Andreas Meyer‐Lindenberg, Erich Seifritz, György Szekeres, Norbert Skokauskas
Journal: World Psychiatry (2023)

The Russian invasion of Ukraine – starting on February 24, 2022 – is a global catastrophe. It is a moral and a public health crisis posing challenges for individuals, families and nations. Leaders of international and national psychiatric associations gathered in Warsaw, Poland on February 24, 2023, aiming to work together to address the horrific consequences of an immoral war, and the traumatic damage both within and beyond the war zones. For this purpose, there must be a careful consideration of what is necessary to provide peace and safety in Ukraine and in the hearts of all those who have been deeply affected by this war and the consequential political and economic crisis. It is essential to bear witness to this horrific war, as well as to consider the vital work ahead. Success will require a new political and social order, new health care systems, and a new confidence that political leaders can maintain peace in a rapidly changing global world that faces other looming crises. The leaders of the psychiatric associations posed the following questions: a) what is the impact of the Russian war on Ukraine and the world?; b) how has the global crisis due to the Russian war affected mental health and mental health systems in other countries?; c) what lessons can be learned from this global medical, economic, political and moral crisis?; d) what are the roles of public entities, including the WPA, the European Psychiatric Association (EPA) and other international and national professional societies, as we face these moral and medical challenges? Some of these questions are specific to Ukraine and its people; others are relevant to crises facing all countries. Death, destruction, forced migration, as well as economic disparity and disruption are all too common in the contemporary world, creating an uncomfortable and unsettling context within which the Ukrainian situation must be considered. This context creates catastrophic effects that are overwhelming already inadequate systems of care, in Ukraine and beyond. Children and young families are at highest risk, because their social support systems are being destroyed, their schools and career opportunities are disappearing, and their homes and families are being obliterated by rockets. The Ukrainian infrastructure – especially energy systems, public institutions, schools and hospitals – have been deliberately targeted and destroyed, with many deaths of innocent non-combatants considered merely “collateral damage”. As the terror continues, a large proportion of the population is experiencing symptoms that are often the prodromes of traumatic disorders, while symptoms of anxiety, depressive and other mental disorders are being exacerbated. The situation is worsened by the loss or absence of clinical caregivers, psychosocial support, medications and other essentials for patient care. The levels of trauma from the Russian invasion of Ukraine are unprecedented. The start of the Russian war in Ukraine has followed the death and disability from the COVID-19 pandemic and the ravages of climate change. Disaster is building on disaster, leaving people and resources depleted. The magnitude of destruction in Ukraine and its impact on the world are astounding. The real impact on people is captured by the numbers1, 2: from a 2019 Ukraine pre-war population of 43.7 million people, there are now 13.5 million people displaced (5.4 million internally and 8.1 million externally). The best of Ukraine’s next generation is in jeopardy, with many already dead or maimed. For those who have survived, schooling and careers have been put on hold or destroyed. Many buildings and businesses have been destroyed and supply chains disrupted. Homes and schools are gone, livelihoods irreparably damaged, hospitals unable to provide care, and civil infrastructure (power, water, food, Internet, government services) limited. Eight million Ukrainian refugees have flooded other countries2. Another estimated 1.6 million have been forcibly “evacuated” to Russia3. Ukraine’s agricultural production has been disrupted by Russia’s blockade of exports and placement of landmines in wheat fields, leaving millions at risk of starvation, since 40% of World Food Program grain comes from Ukraine. Additionally, there is grave environmental danger, especially with Russian attacks on nuclear power stations and threats to use nuclear weapons. Solutions to crises are never evident nor easy. The pursuit of peace with justice will always be our foremost goal, with a full Russian withdrawal from the Ukraine’s territory, massive rebuilding within Ukraine, restoration of public infrastructure (including the mental health and general health care systems), and restoration of grain shipments to the developing world. World leaders in the mental health and general health fields can promote peace and prosperity, while making every effort to manage the mental health crisis facing Ukrainians at home and abroad, by: a) bearing witness to the atrocities and violence committed in this war, and wherever they occur; b) identifying the expanding mental health crises associated with war and forced migration; c) supporting sanctions against Russia with the goal of increasing the burden of the war on Russia; d) supporting Ukraine, its people, and the Ukrainian Psychiatric Association. The WPA and other psychiatric associations around the world should: a) speak out about the moral and clinical crisis and its worldwide implications; b) support services for the growing mental health crises, by: i) providing training for mental health professionals serving Ukrainian refugees, along with broad-based mental health collaborations; ii) developing mental health services tailored to address the trauma and other consequences of the Russian war; iii) providing medications and other resources to treat patients with mental health needs; iv) developing remote tele-mental health services, making treatment available for all; v) preparing to re-build Ukrainian facilities, services, and education systems, so that Ukrainians can benefit from the skills and resources of modern psychiatric practice; vi) establishing research programs, so that Ukrainians and people of other countries can learn from these circumstances and be better prepared, if such events occur in the future. World leaders in the mental health and general health fields should: a) support the process of bringing war crimes prosecutions before the War Crimes Tribunal in The Hague, and human rights violations before the European Court of Human Rights, as part of the recovery process for Ukraine’s collective trauma; b) recognize and address the special needs of children and young families (i.e., i) provide safety and security for all children, including shielding them from the atrocities of war, trafficking, and emotional and physical damage; ii) provide parent guidance and support for families who are displaced or facing the trauma of injury, war crimes, and death; iii) help children maintain contact with family members from whom they have been separated; iv) build online facilities to re-establish supportive social networks for developing youth; v) sustain virtual Ukrainian schools, so that children who had to leave homeland can continue their intellectual and social development, while also giving them the tools and hopes for a future in Ukraine; vi) provide evidence-based general interventions that give comfort and promote resilience, such as mindfulness training and evidence-based single-session interventions); c) never forget: the Russian war; the Ukrainian people; the threats to all of us; the need to promote healthy development, mental health, and peace. There is great power in unity. Now is the time to stand together. A strong way to support resilience and recovery is for medical and mental health professionals to speak in one voice supporting the end of this and other wars.